Malignant phyllodes tumour presenting as a massive fungating breast mass and silent thrombo-embolism

• Massive phyllodes tumour has a higher chance of being malignant.
• Staging imaging is undertaken to confirm and define local chest wall invasion.
• An associated silent DVT/pulmonary embolism should be considered.
• Pre-operative diagnosis of DVT/Pulmonary embolism changes peri-operative planning.
• Peri-operative morbidity/mortality is reduced by recognising DVT/Pulmonary embolism.

IntroductionWe report an unusual case of a massive malignant phyllodes tumour that had almost replaced the entire breast presenting with severe chronic blood loss, extensive deep venous thrombosis (DVT) and a silent pulmonary embolus.PresentationLong-standing neglected massive fungating ulcerative mass larger than the left haemothorax.DiscussionPhyllodes tumours are rare fibro-epithelial breast lesions that have the propensity to grow rapidly to a large size if neglected. Larger tumours are more likely to be malignant with an overall metastatic rate around 10%. An incidental pulmonary embolus arising from extensive silent lower limb deep vein thrombosis requiring an IVC filter complicated the surgical management.ConclusionPhyllodes tumours are rare and account for approximately 0.3–0.5% of all breast tumours [1]. They have the propensity to be fast growing. However, tumours reaching a massive size (>10 cm) are rare with few reports in the literature.